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 HAND HYGIENE  LINE NECESSITY  HAND HYGIENE  LINE NECESSITY

HAND HYGIENE LINE NECESSITY - PowerPoint Presentation

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Uploaded On 2020-04-09

HAND HYGIENE LINE NECESSITY - PPT Presentation

Change IV tubing and needleless connectors every 96 hours Daily CHG bathing Change bed linens and gowns daily Do not draw routine blood cultures from central lines Appropriate hand hygiene upon entering and exiting every patient room ID: 776533

line blood amp video line blood amp video dressing chg change cultures curos access needleless wipes tubing clabsi bundle

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Presentation Transcript

Slide1

HAND HYGIENE

LINE NECESSITY

Change IV tubing and needleless connectors every 96 hours

Daily CHG bathing

Change bed linens and gowns daily

Do not draw routine blood cultures from central lines

Appropriate hand hygiene upon entering and exiting every patient room

Can line be removed

Does patient have a peripheral line

Use Curos caps

on every port

and

every line

Scrub the hub (needleless connector) prior to accessing

Dressing clean, dry, intact & current

Dressing change Q7days and PRN

DRESSING

CLABSI

CUROS CAPS

SITE & LINE INSPECTION

TUBING & NEEDLELESS CONNECTORS

CHG BATHING

BLOOD CULTURES

Bundle

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Assess at least every shift:

Site and line inspection

Blood return

ADULT & PEDIATRIC

Slide2

Assess Line Necessity Every Shift!

CLABSI

Bundle

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ADULT & PEDIATRIC

INDICATIONS:

Examples include but not limited to:

pharmacy link with full text

Vesicant or irritating medications

Total parental nutrition (TPN)

Peripheral parenteral nutrition (PPN)

Hemodialysis

Advanced hemodynamic monitoring

Lack of adequate peripheral access

Home infusion of medications

Policy #12004

ALTERNATIVES:

Peripheral IV (PIV)

Midline IV

Note:

If long-term line necessity is identified, transition to a PICC and continue CLABSI bundle.

LOCATIONS:

Consider patient condition and treatment needs:

Subclavian

Internal Jugular (IJ)

Femoral:

Frequently re-evaluate for alternative sites or line types

4. PICC:

Placement sites will vary based on age, but usually placed in arm

Slide3

Place a Curos cap on every hub (needleless connector) and every access port for both central and peripheral lines.

Place a Curos cap on all peripheral line hubs (needleless connectors)

even if

a patient doesn’t have a central line!

Change Curos cap when accessing and with tubing changes.

Curos caps are

single use!

Must discard upon removal and apply a new Curos cap.

Scrub the hub for 10 seconds

in addition to Curos caps.

Once a Curos cap is removed, scrub the hub (needleless connector) with alcohol pads for 10 seconds prior to access and between each medication administration!

CLABSI

Bundle

Curos Cap On Every Hub, And Every Line, Every Time!

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NEW

WATCH VIDEO!

“Scrub The Hub For 10 Seconds Prior to Access and Between Each Medication Administration”

NEW

ADULT & PEDIATRIC

Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.

ADMINISTERING MEDICATIONS:

CUROS CAPS AND TIPS:

CVC & PIV LINES:

Slide4

CLABSI

Bundle

Dressing change

frequency:

Once per week, and

PRN for visibly soiled or compromised dressings

Visibly

soiled/compromised

dressings:

Excess blood & bodily fluids

External contaminants

Skin breakdown

Label requirements:

initials & date dressing change was performed

Avoid

premature dressing changes:Wait the full week unless the dressing is compromised!Increased disruptions equals increased risk for infection!

Fluids underneath occlusive dressing create:

A medium for bacterial growth, and

Increase the risk for infection

During routine bathing:Always secure and protect dressingsIf a Biopatch is more than 50% saturated with blood/fluids:Perform a dressing change and replace the Biopatch.

Dressing application considerations:

Location & surface area

Skin texture & creasesHair growthTo improve adhesive contact use:Skin prep wipes Adhesive spraysTo prevent loose dressings:Monitor the edges Secure external portsIf dressing edges are peeled back into the clear window, a dressing change is required, otherwise dressing reinforcement is acceptable!

Dressing: Clean, Dry & Intact!

WATCH VIDEO!“Performing A Proper CVAD Dressing Change”

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Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.

ADULT & PEDIATRIC

NEW

NEW

INTACT

DRESSING

DRY

DRESSING

CLEAN

DRESSING

Slide5

Assess

Signs & Symptoms Every Shift:

Erythema & Swelling

Drainage & Leaking

Pain & Burning

Itching & Infiltration

Cellulitis

Catheter secure/patent

Assess Line Migration:

Assess length (cm) of line outside the body with every dressing change

Blood Return:

Perform

blood return check

at least every shift!If No Blood Return Is Noted:Reposition and/or roll patient Troubleshoot line (confirm line is unkinked & unlocked)If clotted line is confirmed, call MD for an order of Cathflo (alteplase)Pediatrics:Pressure alerts: be aware of pressure alert frequencies signaling a line occlusion

 

Dialysis Catheters (Permanent): RNs must have demonstrated competency in order to flush any dialysis catheter lumensTrialysis Catheter/Pigtail (Temporary):Treat pigtail as a central line!Check blood return and flush pigtail every shift!RNs must have demonstrated competency to flush all other temporary dialysis catheter lumens

DIALYSIS LINES

CLABSI

Adult Guidelines:

Flush 8-10ml NS prior to access and between each med administration

Flush 20ml NS after blood draws & blood infusions

Pediatric Guidelines: Flush 5-10ml NS prior to access and between each med administrationFlush 10ml NS after blood draws & blood infusionsFlushing Technique:Flush using push-pause techniqueDetach syringe with positive pressure, clamp line and attach Curos cap

FLUSHING GUIDELINES

Bundle

Site & Line Inspection Every Shift!

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Trialysis Cath (Pigtail)

WATCH VIDEO!

“Administering Cathflo”

Attention!

Never Replace Dialysis White Caps with Green Curos Caps!

Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.

ADULT & PEDIATRIC

Slide6

Every 24 hrs:

TPN, Lipids, Lorazepam

Every 12 hrs:

Propofol, Mannitol

Every 4 hrs:

Blood (or every 2 units whichever occurs first)

Policy #11958

Change IV tubing every 96 hours:

MaintenanceIntermittent PiggybackNote: Tubing should be changed anytime the line has been compromised (i.e. the line came apart from the IV and is dangling at the bedside)

Back Priming Method:If the primary IV bag and the IV piggyback are compatible (even multiple IVPBs) use back priming method instead of multiple secondary tubing!

CLABSI

Bundle

Needleless Connectors:

Change every 96 hours with IV tubing changes OR when

blood residual

remains

Do not remove or change needleless connector after drawing blood from line

Flush well after blood draw and only change needleless connector if and when blood residual remains

Note:

change needleless connectors when drawing blood cultures!

IV Tubing & Needleless Connectors!

WATCH VIDEO!

“Back Priming Secondary IV Tubing”

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BLOOD DRAWS

NEEDLELESS

CONNECTORS

TUBING INTERVALS:

NEEDLELESS CONNECTORS:

BLOOD DRAWS:

SECONDARY TUBING:

IV TUBING CHANGE:

Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.

ADULT & PEDIATRIC

Slide7

CLABSI

Bundle

CHG BATHING!

WATCH VIDEO!

“CHG BATHING”

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CHG COMPATIBLE

PRODUCTS

ANTIMICROBIAL

ACTIVITY

BATHING PROTOCOL:

ANTIMICROBIAL ACTIVITY:

CHG COMPATIBILITY:

STRAGETIC USE OF WIPES:

DAILY USE & GUILDELINES:

Access the video by scanning the barcode with a smartphone or by clicking on the direct video link below.

ADULT & PEDIATRIC

DAILY USE

of CHG wipes for all patients with:

CVC

’s/PICC’s/Dialysis lines/Accessed Mediports

&

ALL ICU patients

GUIDELINES

Do NOT flush wipes or leave them behind in patient rooms.

Do NOT use wipes on patients with a rash or an allergy to CHG.

May bathe patient prior to using CHG wipes.

Use CHG compatible bathing wipes (make sure to toss all used wipes in trash).

Bathe with CHG wipes in the order shown in the diagram (on back).

Use all 6 wipes:

Always bathe the body part associated with the CVC line first, then clean 6 inches of the line nearest the patient, then bathe the opposite limb.

Apply clean linens and gowns after CHG is dry.

CHG has antimicrobial activity that lasts for 24 hours.

Massage wipes firmly into skin.

Do NOT wipe off CHG wetness/moisture, allow CHG to completely air dry.

Only use CHG compatible barrier products and lotions.

CHG wipes are alcohol free and contain moisturizers.

Slide8

Use all 6 wipes:

Always bathe the body part associated with the CVC line first, then clean 6 inches of the line nearest the patient, then bathe the opposite limb.

Slide9

CLABSI

Bundle

Increased length of hospital stay

Misdiagnosis of hospital acquired infections

Increased costs

Unnecessary use of antibiotics

Practice Aseptic Technique:

Use CRMC’s triple cleanse procedure

Always draw blood cultures prior to initiation of any antibiotics

Lab Must Draw Cultures Whenever Possible:

Lab has a contamination rate of less than 1%! (nursing is at 6%!)

Blood Cultures!

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Peripheral Blood Cultures:

Draw peripheral blood cultures whenever possible

Central Line Blood Cultures:

Do not draw from central lines (due to high rates of contamination)

UNLESS

the physician is ruling out specific line infection

Wait 15 minutes between blood cultures that are pulled through a central line

Insufficient quantity of blood may give false results!

PROCESSES

: Step-By-Step Instructions On Back

WATCH VIDEO!Access the videos by scanning the barcodes with a smartphone or by clicking on the direct video links below.

ADULT & PEDIATRIC

CONSEQUENCES OF CONTAMINATION:

AVOID CONTAMINATION:

Drawing a Central Line Blood Culture

Slide10

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Peripheral Blood Cultures

*Only perform if lab can’t draw blood cultures

Central Line Blood Cultures

*Not recommended unless a physician is specifically ruling out a line infection

Remove alcohol pad Place adaptor cap on aerobic bottlePress down to penetrate septumTransfer blood from patient to bottle

CLABSI

Bundle

WATCH VIDEO!

ADULT & PEDIATRIC

“Drawing A Central Line Blood Culture”

Access the videos by scanning the barcodes with a smartphone or by clicking on the direct video links below

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